7.4.1 When to start using an IUCD
An IUCD is usually inserted during a menstrual period, when the cervix is slightly open and pregnancy is least likely. There is, however, a greater chance of expulsion if a device is introduced early in the cycle, because the uterus can squeeze the device back out. Therefore, the best time for insertion is just after a period. However, an IUCD may be inserted at any time. Table 7.1 shows the best timing for IUCD insertion for women in different situations.
Table 7.1 Time of IUCD insertion.
|Woman’s situation||When to start|
|Having menstrual cycles|
• Any time within the first 12 days after the start of menstrual bleeding, preferably after bleeding has stopped, at the woman’s convenience.
• Any other time during the menstrual cycle (not just during menstruation) if the woman is not pregnant and has a healthy uterus.
• If a woman has been using a reliable contraceptive, or has not been having sex, the best time to insert her IUCD is when she asks for it.
• During a hospital or health centre stay following childbirth, if she has decided voluntarily in advance. The IUCD is best inserted within ten minutes of delivery of the placenta.
• It can be inserted at any time within 48 hours after childbirth (special training is required).
• If not immediately after childbirth, then as early as four weeks after childbirth for Copper T IUCDs, such as TCu-380A. At least six weeks after childbirth for other IUCDs.
|After miscarriage or abortion|
• Immediately, if no infection is present.
• If an infection is present, treat it and help the client choose another effective method.
• The IUCD can be inserted after three months, if no infection remains and re-infection is not likely, and the woman is not pregnant.
|Lactating mothers with lactational amenorrhoea (LAM)|
• Any time, providing the mother is not pregnant.
|When stopping another method|